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I will be installing the following: <br /> Tanks <br /> Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other <br /> (list manufacturer) <br /> Number of Tanks: &* 3 <br /> Size of Tanks: O Z �7 a a C> <br /> Treatment System <br /> Trenches s.f. <br /> Mound �— s.f. <br /> Gravel less s.f. <br /> Chamber s:f. <br /> Final Cover/Top Soil <br /> to be borrowed from site (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system <br /> installation permit, agrees to do all the work in strict accordance with ordinances of the City <br /> and regulations of the State of Minnesota and certifies that all statements made on this <br /> application are complete, true and correct. <br /> Signature of Applicant Date: <br /> MPCA License No.: G- l 5, 3 <br /> Staff Review: Accept ❑ Denied <br /> Reviewer: Date: <br /> Reason for Denial: <br /> Comments (to be printed on inspection card): <br /> 2 /2 VA(Permits)\Septic System Permit Application.doc <br />